Who must choose a health plan?

Main Content

Who must choose a health plan?

Most people in NC Medicaid must choose a health plan in the NC Medicaid Managed Care program, including:

  • Most families and children
  • Children who get NC Health Choice
  • Pregnant women
  • People who are blind or disabled and do not get Medicare

NC Medicaid will send you a letter that tells you if you must enroll. To find out now, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online. To learn more about NC Medicaid Managed Care, go to Get answers.

Who may choose a health plan?

Some people in the NC Medicaid may choose a health plan in the NC Medicaid Managed Care program, including:

  • Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region
    • They may choose to enroll in the Eastern Band of Cherokee Indians (EBCI) Tribal Option. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider.
  • People who need certain services to address needs related to developmental disability, behavioral health, traumatic brain injury or substance use disorder

For questions, call the NC Medicaid Contact Center at 1-888-245-0179. To learn more about NC Medicaid Direct, go to Get answers.

Who cannot choose a health plan?

Some people cannot choose a health plan in the NC Medicaid Managed Care program because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. For example:

  • People who get Family Planning Medicaid only
  • People who are medically needy
  • People in the Health Insurance Premium Payment (HIPP) program
  • People in the Program for All-Inclusive Care for the Elderly (PACE)
  • People who get Refugee Medical Assistance
  • Children in foster care
  • Children who get adoption assistance
  • Children who get Community Alternatives Program for Children (CAP/C) services
  • People who get Community Alternatives Program for Disabled Adults (CAP/DA) services
  • People who get Medicaid and Medicare
  • People who get Innovations Waiver services
  • People who get Traumatic Brain Injury (TBI) Waiver services

To learn more, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online.